Occurrence, Characteristics and Treatment of Schizophrenia
Although there is evidence that schizophrenia was recognized during ancient times, the term is a relatively new term introduced by Eugen Bleuler in 1911 - Occurrence, Characteristics and Treatment of Schizophrenia introduction. The condition was first described by Emile Kraepelin in 1887, labeled as “Dementia praecox. ” Characterized by delusions, hallucinations and distorted thinking, the condition is treated with antipsychotic drugs such as chlorpromazine, haloperidol and trifluoperazine, first produced in the 1950s, and with newer drugs such as clozapine sometimes referred to as “atypical antipsychotic drugs”.
Treatment outcome varies, but about one third of those with the condition recover, one third improve and another third remain unchanged. Schizophrenia Introduction Although the word schizophrenia is relatively new, less than 100 years old, the disease has been known for millennia. Scholars believe that the disease is described in detail in some books of antiquity and was generally associated with the heart rather than with the brain and mental illnesses were viewed as physical ailments.
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Despite its apparent long history, schizophrenia was first described as a mental illness in 1887 by Emile Kraepelin who used the term “Dementia praecox” at the time for the symptoms now viewed as schizophrenia (see below). Often viewed today as madness, it has been viewed similarly in early times. For example, during the 5th and 4th centuries BC, the Plato and the Greeks thought that two types of madness existed, one referred to as divine (that led to or created prophets) and another of physical origin. Kraepelin, whose studies focused on young adults with the condition, was the first to distinguish between psychosis and manic depression.
He viewed psychosis as a brain disease that was a form of dementia, a demented state, and chose to separate it from Alzheimer’s disease, viewed as another form of dementia. Kraepelin was the first person to distinguish between psychosis and manic depression. He viewed psychosis as a brain disease that was a form of dementia, a demented state, and chose to separate it from Alzheimer’s disease. In 1911, the Swiss psychiatrist, Eugen Bleuler, introduced the term “schizophrenia” and noted that the condition could occur early in life and need not lead to mental deterioration.
What is Schizophrenia? Although many people think of schizophrenia as a “split personality’, that is not the case. Individuals with split personalities are diagnosed as having multiple personality ‘disorder’. (There is reason to believe that some situations diagnosed as multiple personality ‘disorders’ are not actually ‘disorders’ at all, but true multiple personalities housed within the same individual, with only one normal ‘resident’ personality. This view is not acknowledged in psychology, but it is not uncommon.
For example, the late author Jane Roberts who wrote the Seth books attributed them to “Seth”, a personality who used her body to communicate. Anyone who reads her work and that of “Seth” can clearly see that the writing styles are very different. Despite the presence or existence of Seth, there is no evidence that Jane Roberts had a split personality. ) Kraepelin, whose studies focused on young adults with the condition, was the first to distinguish between psychosis and manic depression. He viewed psychosis as a brain dysfunction.
In general, schizophrenia involves delusions, auditory hallucinations and disorganized thoughts. The auditory hallucinations generally involve the patient ‘hearing voices’. In general, schizophrenia involves delusions, auditory hallucinations and disorganized thoughts. Symptoms: Kraepelin, whose studies focused on young adults with the condition, was the first to distinguish between psychosis and manic depression. He viewed psychosis as a brain disorder. Schizophrenia in affected patients is characterized by the appearance of unusual realities, hallucinations, delusions and distorted thinking.
Schizophrenics view the world from their own perspective, a perspective that is generally strikingly different from the way other individuals around them view the world. This can cause the schizophrenic individual to feel anxious and confused. Their world is often filled with hallucinations, especially auditory hallucinations that involve hearing voices of people telling them to do things. Visual and other sensory hallucinations are not uncommon either. Schizophrenics are subject to delusional thinking as well.
They often have false and irrational beliefs that are not subject to reason and are strikingly different from the culture in which they live. Delusions of grandeur or persecution are common characteristics in schizophrenic individuals. Delusions of persecution and associated irrational beliefs of being harassed, cheated, etc. , are common in paranoid schizophrenia. Schizophrenic individuals are often characterized by disorganized thinking. This is sometimes referred to as “affective disorder. ” Affective disorders might be intermittent, but may last for hours.
In some affective disorder situations, thoughts may come so rapidly that the individual may be unable to concentrate and thus, the patient may not be able to connect thoughts in a logical manner. Their thoughts are disorganized, fragmented and discontinuous. These discontinuous thoughts are referred to as ‘thought disorder. ’ They make communication with other people very difficult since others cannot follow their line of reasoning. One characteristic common to schizophrenics and not mentioned above is inappropriate emotional expression.
This is characterized emotional expressions that do not fit the current situation around them. They may laugh at sad situations or cry in happy ones. This feature is not uncommon in ‘normal’ individuals, but the behavior in schizophrenics can be noticeably different. At times, their emotional expression is monotone and more or less without the ‘normally expected’ facial, vocal or emotional expressions at all (generally viewed as depression), or they can have prolonged states of elation (mania) or depression. When both states coexist, schizophrenics are viewed as being bipolar—manic-depressive.
Bipolar situations are referred to as ‘schizoaffective disorder’ when they cannot be clearly categorized. Causes and Occurrence Schizophrenia affects about 1 percent of the population. Men and women are affected with equal frequency. It generally begins in the teens or early twenties and is rarely seen before the age of 5. Although genetics may play a role in the condition, genetics and environment are thought to contribute to schizophrenia, but it is not entirely a genetic condition. The more closely related individuals in a family are, the more likely they are to be schizophrenic if the condition exists in the family.
For example, siblings are less likely than fraternal twins than identical twins to have the condition if it exists in the family. However, the genetic correlation is not strong. Even identical twins have slightly less than a fifty percent chance of sharing the condition. Therefore, while genes may play a role in an individual’s susceptibility to schizophrenia, genes alone are not entirely responsible for it. (Gottesman, 1991) Research suggests that ‘normal’ behavior, enhanced thickening of the cerebral cortex and a greater number of hippocampal neurons require and enriched social environment (Kemperman et al. 1997). When orphans are raised in an isolated, impoverished social environment, their development is markedly retarded, perhaps not to the extent of being schizophrenic, but sufficiently enough to consider that the deprived social conditions might contribute to a schizophrenic state. Research suggests that the social engagement and linguistic interaction associated with the enlargement of the forebrain and the association cortex during evolution is necessary to prevent the hippocampal neurons from diminishing.
Nerve cells form neural connections that are partially induced to form by the release of neurotrophins during neuronal activity. In the eye, for example, this activity loss can be overcome by the localized infusion of a neurotrophic factor, neurotrophin NT-4. In general, some functional loss similar to schizophrenia can arise without this activity. Researchers believe that, as has been demonstrated for vision, excessive activity or stress and other factors involved in social deprivation might damage cortical and subcortical structures involved in concentration, social functioning, speech and other sensory and social interactions.
Neurology of the Disease Schizophrenia is associated with several structural and neurochemical abnormalities. Even though schizophrenia occurs with common frequency in males and females, Schwartz and Fishe (2001) noted sex differences in schizophrenic patients. For example, although the gray matter was about equally reduced in males and females, there were sex differences in the amygdala, part of the limbic system (involved with emotions). Researchers have learned that temporal lobe structures are involved in cognition and emotion.
MRI studies show that schizophrenics have temporolimbic abnormalities. Men and women have less hippocampal gray matter, both reduced by about the same amount, but there are sex differences with regard the amygdala. In one study, the amount of superior temporal gyrus in men was reduced by nearly three times over that in women (Gur et al. , 2000). In women, the decrease did not exceed that seen for the brain as a whole. This led Gur et al. to conclude that schizophrenia involves reduced gray matter in temporolimbic structures.
Although dopamine is the neurotransmitter most commonly associated with schizophrenia, other transmitters have been implicated in the condition. While the most prevalent ideas as to the neurotransmitters involved with schizophrenia and depression were once limited to dopamine in schizophrenia and noradrenaline and serotonin in the case of depression, it is now clear that many neurotransmitters ranging from dopamine, -aminobutyric acid (GABA), glutamate, opioid, serotonin, or acetylcholine may be involved.
It is not easy to make sense of the complicated biochemistry of these conditions. However, today, the dopamine concept certainly does not stand alone. The dopamine theory of schizophrenia predominates because dopamine agonists, compounds the mimic the effects of dopamine, can cause or exacerbate psychotic symptoms. (Davis et al. , 2002) However, postmortem anatomical studies have not confirmed this observation. Both excitatory transmitters like dopamine and serotonin and inhibitory transmitters such as glutamate are thought to be involved with the condition.
Perhaps the only general conclusion we can reach today as to the neurochemistry of the condition is that no single neurotransmitter is involved. Treatment and Treatment Outcome Although schizophrenia can be treated with some degree of success, the outcome varies a great deal. (Harrison et al. , 2001) About one third of those diagnosed with the condition recover, another third improve and about one third show little or no change. Harding et al, 1987) Schizophrenia is treated with antipsychotic drugs (Royal College of Psychiatrists, 2003) such as chlorpromazine, haloperidol and trifluoperazine. These drugs, developed in the 1950s, have become the central line of defense in treating the condition. They can reduce psychotic symptoms in 7 to 14 days. Newer drugs such as clozapine (which can cause weight gain), referred to as “atypical antipsychotic drugs”, have recently been developed and are generally preferred for the initial treatment of the condition.
Other methods of treating the condition include psychotherapy, cognitive behavioral therapy (CBT), family therapy/education and electroconvulsive therapy, not considered as an initial approach, but one that might prove valuable when other approaches have failed. CBT is used to help patients improve their self-esteem and related issues. Family therapy and education is of value because the entire family must be involved in dealing with the condition. Summary and Conclusion In conclusion, although the term “schizophrenia” is relatively new, coined less than 100 years ago, the condition appears to have been recognized for millennia.
Schizophrenia is characterized in individuals by delusions, hallucinations and disorganized thoughts (affective disorders). It occurs in about one percent of the population and, although it is more likely to occur in families where it already exists and can be connected to individuals who are more closely related, a clear causative genetic link has not been established. The once prevalent view that dopamine is the neurotransmitter most responsible for the condition has given way to recognizing that many transmitters appear to be involved.
Anatomically, the condition has been connected to temporolimbic abnormalities that involve the hippocampus and the amygdale. Although antipsychotic drugs first produced in the 1950s still prove to be among the most effective and valuable tools for treatment of the condition, new drugs labeled “atypical antipsychotic drugs” are appearing and appear promising. Although schizophrenia can be treated and some treatments have favorable outcomes, in general treatment success varies greatly and there is no guarantee of success.